197610044-10-1-2025-29-AS-KHEN-DMWVT3-20251029164227

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610044
Report Date: 10/01/2025
Date Signed: 10/01/2025 02:46:19 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/23/2025 and conducted by Evaluator Quoc Huynh

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20250923091622

FACILITY NAME:	MARY'S CHATEAU		FACILITY NUMBER:	197610044
ADMINISTRATOR:	PETIKYAN, MARY		FACILITY TYPE:	740
ADDRESS:	13912 VALERIO STREET		TELEPHONE:	(323) 333-8105
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	6	CENSUS: 5	DATE:	10/01/2025
		UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Mary Petikyan - Administrator		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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9

Staff do not meet a resident's hygiene needs
Staff do not properly groom a resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced initial complaint visit for the above allegations. LPA arrived at 9:33AM and met with the Administrator Mary Petikyan, who arrived at 10AM. Entrance interview conducted.

Beginning at 10:03AM, the LPA and Administrator conducted a brief tour to ensure the health and safety of the residents in care, and no immediate concerns were observed. Record review at 10:07AM revealed that the complaint was created under the wrong facility address as Resident #1 (R1) resided in another facility licensed by the same Licensee.

No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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